GDV

Question 1

Which breeds are predisposed to GDV?

Answer 1

Large, deep-chested breeds

Question 2

Which breed is the poster child for GDV?

Answer 2

Great dane

Question 3

What is the approximate mortality rate for GDV?

Answer 3

15-30%

Question 4

What are common clinical signs of GDV?

Answer 4

Non-productive retching/vomiting, abd distension, hypersalivation

Question 5

What is the pathophysiology of GDV?

Answer 5

Counter-clockwise rotation of the stomach (view from Cr to Ca in dorsal recumbency)

Question 6

How does volvulus of the stomach cause cardiovascular problems?

Answer 6

Venous compression, congestion, and local blood perfusion compromise to the stomach (necrosis)

Question 7

Which vessels can be torn d/t a gastric volvulus?

Answer 7

Short gastric vessels

Question 8

What do the short gastric vessels connect?

Answer 8

Connect stomach and spleen

Question 9

What type of shock does GDV cause?

Answer 9

Obstructive or hypovolemic

Question 10

What radiographs are diagnostic for GDV?

Answer 10

R lateral

Question 11

What sign do we see on R lateral radiographs that is definitive of GDV?

Answer 11

“Double bubble”

Question 12

What is the likelihood that a Great Dane will develop GDV in its lifetime?

Answer 12

37%

Question 13

What other factors of a dog’s lifestyle predispose them to GDV?

Answer 13

Anxiety, very fast eaters

Question 14

What arrhythmia is most likely assoc. w/GDV?

Answer 14

VPCs

Question 15

When are arrhythmias assoc. w/GDV most likely to occur?

Answer 15

Especially after surgery

Question 16

What will a GDV blood gas analysis show?

Answer 16

Metabolic acidosis

Question 17

How do you stabilize a GDV patient?

Answer 17

2 large bore cephalic catheters + shock dose crystalloid fluids, decompress stomach

Question 18

Why should you try to avoid putting catheters in the saphenous veins of a GDV?

Answer 18

Caudal venous return is poor

Question 19

What is the shock dose of crystalloid fluids in a dog?

Answer 19

80-90mL/kg

Question 20

What are pros of using an orogastric tube to decompress the stomach?

Answer 20

More effective emptying

Question 21

What are cons of using an orogastric tube to decompress the stomach?

Answer 21

Requires heavy sedation, tube might not pass, possible esophageal trauma/rupture

Question 22

What are pros of trocarization to decompress the stomach?

Answer 22

More rapid intervention, does not require sedation

Question 23

What are cons of trocarization to decompress the stomach?

Answer 23

Limited decompression, risk of lacerating gastric wall, puncturing spleen

Question 24

What lactate levels might predict gastric necrosis?

Answer 24

Greater than 6mmol/L

Question 25

What lactate levels are generally associated with a good prognosis?

Answer 25

Less than 6mmol/L

Question 26

What is the goal of GDV surgery?

Answer 26

Fully decompress and reposition the stomach

Question 27

When you enter the abdomen of a GDV, what will you see?

Answer 27

Omentum drape covering the stomach

Question 28

How can you prevent a GDV from occuring/reoccurring?

Answer 28

Gastropexy

Question 29

Which gastropexy technique poses a risk for future abdominal surgery on the dog and why?

Answer 29

Incorporating - tacks stomach to ventral body wall, so if another ex lap is performed, risk of accidentally cutting into stomach when opening the abdomen

Question 30

What are negative prognostic indicators for GDV?

Answer 30

Lactate >6mmol/L, need for gastric resection/splenectomy, long onset of signs to presentation, recumbency at presentation

Question 31

If gastropexy is performed, what is the rate of GDV recurrence?

Answer 31

4%

Question 32

If gastropexy is NOT performed, what is the rate of GDV recurrence?

Answer 32

50%

Question 33

How can you prevent GDV?

Answer 33

Prophylactic gastropexy in predisposed breeds during other routine procedure

Question 34

Which gastropexy technique is considered "best"?

Answer 34

Incisional b/c suture to abd wall and easy

Question 35

Why do you want a R lateral radiograph to dx GDV?

Answer 35

Gas will fill left displaced pylorus

Question 36

How do you reposition the stomach when correcting a GDV?

Answer 36

Push down on fundus, grab pyloric antrum and rotate stomach counterclockwise

Question 37

How might the esophagus appear on radiographs of a GDV?

Answer 37

Dilated from aerophagia

Question 38

Which pain control drugs should you use for GDV?

Answer 38

Opioids for minimal CV effects

Question 39

What drug can scavenge reactive oxygen species to help prevent reperfusion injury?

Answer 39

Lidocaine

Question 40

How soon after repositioning the stomach will peristalsis begin again?

Answer 40

Almost immediately if tissue still healthy

Question 41

Where is gastric necrosis most likely to occur?

Answer 41

Greater curvature near short gastric arteries

Question 42

If the spleen is also twisted, how do you treat it?

Answer 42

DO NOT UNTWIST, splenectomy

Question 43

Does a gastropexy prevent dilation?

Answer 43

No

Question 44

Which gastropexy technique is considered the "strongest"?

Answer 44

Circumcostal

Question 45

What type of gastropexy technique is reserved mostly for prophylactic treatment?

Answer 45

Laparoscopic-assisted

Question 46

Death following GDV usually occur within how much time post-op?

Answer 46

Usually within 4 days

Question 47

What are the main causes of death following GDV surgery?

Answer 47

Shock, gastric necrosis --> peritonitis, cardiac arrhythmias

Question 48

When is it necessary to treat post-op VPCs?

Answer 48

HR >180bpm, multifocal VPCs

Question 49

How do you treat a VPC?

Answer 49

Lidocaine